Conclusion

Texte intégral

“Science without conscience is but the ruin of the soul.”—François Rabelais, 1542

1A special feature of this book is to bring together the work of researchers coming from different disciplines and having various themes of reflection or practices in the field of biomedicine. While the general trend of science goes towards increasing specialization, the project of this book is to look at the use of medical advances in a transversal perspective. In other words, it intends to highlight what unregulated uses of some new technologies in the health sector have in common rather than what differentiates them, and to consider the human body not as the sum of more or less independent organs that require increasingly sophisticated specific treatments, but as a coherent set of interdependent functions that are exposed to similar technical, social, cultural and economic environments. At the centre of this reflection are concepts such as the dehumanization of human beings often reduced to mere objects, the growth of social inequalities, the trade of parts or functions of the human body for health or well-being purposes and the role of health professionals progressively moving away from humanistic principles that have guided medical practice over the centuries.

2Needless to say that this book, which is the result of a work done by international medical and social-science researchers, is in no way a manifesto against science and new biomedical technologies. It gives credit and recognition to the progress made in many areas in recent decades, which often represent a significant contribution to improving health. We believe that scientific progress should be used in the interest of all—respecting the essential ethical principles of medical practice—and not only for those who, thanks to their financial resources, could benefit from these new medical services at the expense of those who often have nothing more than their bodies to rent or sell to survive.

3The metaphor of “cannibal markets” is proposed to describe various phenomena involving the commodification of the human body for medical and well-being purposes. These phenomena refer to the use of human body parts of people living in poverty or brainpower of people living in poor areas to benefit others, more developed, wealthier or more powerful. They are illustrated by four areas of activities: (1) the unregulated global market of assisted reproduction technology and in particular the development of commercial surrogacy; (2) the “brain drain” of health professionals which reduces the capacity of poor countries to respond to their health challenges; (3) the conditions for organ harvesting feeding the market for transplantation in some countries; and (4) the development of commercial institutions that collect, store and sell human material (gametes, embryos, blood, tissues, etc.). Commodification and cannibalization appear as common features of all four areas. Even if cannibalization may seem not to apply to the mechanisms of looting poor countries of their health professionals, it may rather be considered at a social level in the sense that cannibalisation reinforces a central aspect of commodification, which is that “one thing is valued not in itself but as a source of material to benefit another.”

4If the concept of cannibalism, yet used by the great anthropologist Claude Lévi-Strauss (2013, 272), may appear to be offensive to some, the concept of “new forms of slavery” or “modern slavery” that is used by other authors is another controversial denomination. However although these terms could appear as excessive, they reflect situations that are often particularly shocking. In the fields addressed in this book, the violence of words simply illustrates the violence of the conditions in which these markets are developing. As a matter of fact it could be considered that the development beyond the generally accepted ethical limits of some markets in the health sector appears to be nothing but a continuation in more modern forms of ritual cannibalism: a form of cannibalism by incorporating parts of the other by a technological mediation.

5With the technological progress the idea that a failing function or organ could be replaced by a tissue or an organ coming from another person—or by machines—has become a new perspective for curing patients. Today, many parts of the body can be replaced with products coming from other human bodies. This evolution of medicine obviously raises the issue of the origin of the products and the conditions of their collection, conservation and redistribution. An issue of great seriousness as these human products or functions are increasingly coming not from altruistic donations but from an international trade of body parts coming from people belonging to disadvantaged social categories. In this lucrative and poorly regulated market, the idea is promoted that a reasonable amount of money is an adequate way to compensate the loan or the loss of a body part and therefore represents a chance for poor people. In a global environment of growing social inequalities, the respect of human dignity is clearly the key issue for the future of those biotechnologies since the demand of health and well-being products of human origin is increasing whereas the supply side is currently unlimited.

6Beyond the assessment of the poorly controlled development of these new medical markets and their consequences, this book intends to contribute to a reflection on relevant strategies to reduce if not eliminate the global trade of the human body for medical purposes. Should an international legislation—a kind of international agreement—be signed by all countries and would it succeed to regulate these markets? Or, on the contrary, should every country be encouraged to ban such practices at a national level? Should any exchange of money be prohibited or should the idea of an “ethical” price be developed? In other words, is donation still viable in an environment dominated by a neoliberal ideology and a market economy that is often working in grey zones? Is a kind of “official” or “legal” compensation a way to limit the abuses of a poorly regulated market? How to convince or to constraint physicians practicing beyond the legality to respect the ethical rules of their profession?

7These questions and many others will be at the heart of the debates in various international forums in the coming years. We hope that this book will help finding relevant solutions and that the progress of medical science and technology will benefit those who need it and not just those who can afford it, in particular through a black market. On such fundamental issues public awareness should be raised. As Piketty wrote recently (2014, 574) “It is all too easy for social scientists to remove themselves from public debate and political confrontation and content themselves with the role of commentators on or demolishers of the views and data of others. Social scientists, like all intellectuals and all citizens, ought to participate in public debate.” We hope this book will contribute to the much needed reflection and debate on these quickly spreading practices. We believe that it is becoming an urgent and major issue.

Auteurs

Professor of international health and humanitarian action and holds the Social Inequalities, Health and Humanitarian Action chair at the College of Global Studies, Fondation Maison des sciences de l’homme in Paris. Previously he was professor of international health at the Graduate Institute of International and Development Studies in Geneva and director of the Geneva Center for Education and Research in Humanitarian Action. He was also invited professor of development studies and/or humanitarian assistance in various universities, including the Université libre de Bruxelles, Leopold Senghor University of Alexandria, Hanoi School of Public Health and Tel Aviv University, as well as former director of CREDES in Paris, and author of numerous articles, reports and books.

Researcher at the College of Global Studies, Fondation Maison des sciences de l’homme in Paris, and visiting researcher at the Centre of Studies on International Cooperation and Development of the Université libre de Bruxelles (ULB). She earned her PhD in education from the Universitat Rovira i Virgili in Tarragona and conducted various research projects at the ULB and Universitat Autònoma of Barcelona. The overarching theme of her research is science–technology–society: how society relates to scientific knowledge and technical advances, and how these are used in personal and public decision-making.